24 February 2012

Recycling artificial human joints

In 1997, Gabriels and Verberne founded OrthoMetals. Fifteen years
later the company recycles more than 250 tons of metal from cremations
annually...

The company works by collecting the metal implants for
nothing, sorting them and then selling them - taking care to see that
they are melted down, rather than reused. After deducting costs, 70-75% of the proceeds are returned to the crematoria, for spending on charitable projects.

"In the UK for example," he says. "We ask for letters from
charities that have received money from the organisation we work with in
the UK and we see that the amount we transferred to them has been given
to charity. This is a kind of controlling system that we have."..

In Verberne's native Holland, some 57% of all bodies are cremated.
Britain is the biggest cremator in Europe with 73%. And since the
Catholic church eased its opposition to cremation, the company has seen
growth in places such as Italy and Spain. In all, it operates in 15
countries.

The article emphasizes that the hips are recycled as scrap metal, not reused as hip implants again, and I congratulate the Dutch company for their efforts to see that the proceeds go to charity. But... the cynic in me wonders if with this kind of price discrepancy -

"The operation to provide a new hip may cost you around £5,000 ($8,000. 6,000 euros)," he explains. "But the return value as scrap is maybe, per kilo, around £10 ($16, 12 euros). And there are five hips per kilo!"

- that there must be less ethical crematoria that harvest metal implants and sell them into the grey market for reimplantation, perhaps in third-world countries where new prosthetic joints would be prohibitively expensive.

The story also reminds me that when I arranged for my father's cremation twenty years ago, I was tempted to ask the crematory staff what would be done with my father's gold tooth fillings (he probably had several ounces). In the end, I didn't inquire - but suppose those teeth were yanked before cremation and went into some staff member's pocket.

10 comments:

Artificial joints are not just hunks of metal, and even the metal, which must be smooth and unpitted, is almost certainly not usable fresh from the crematorium. So melting these things down and re-making them is almost a necessity. And a lot of metal these days is recycled anyway, so what's the difference whether your hip was previously a hip, hubcap, or aluminum foil covering over someone's plate of leftovers?

Metal objects' value is not based on their worth as scrap; metal does fatigue. Implants wear out. I doubt that anyone rich enough to afford an implant would be dumb enough to try and reuse an old one...that's just bad economy, like reusing a used cylinder-head gasket or dry-rotted inner tube.

The price markup from cost of surgery includes, but is definitely not limited to the cost of the hip implant itself. You'd also be paying for the surgeon, surgery attendants, anesthesiologist, recovery care, and bed.

I have no idea what the parts markup is, but it is definitely NOT as broad as you have implied.

I quite understand that the cost of hip replacement is way more than the cost of the prosthetic insert itself. In the U.S. I think the procedure costs may $25-50,000.

I don't know what the cost of the prosthetic device per se is - it would depend on the type (cemented or not, size, type of metal). I tried to search it tonight and found a used one described this way: "It is for collecting purposes only. Items like this one typically cost between one to six thousand dollars" at this auction site -

http://www.worthpoint.com/worthopedia/medical-hip-implant

- but couldn't find out what it sold for. Not that it would be relevant since it was not suitable for reuse implantation.

I did find an article in the Journal of Epidemiology and Community Health (a British publication), written in 1999 -

jech.highwire.org/content/53/9/542.full.pdf

- Their Table 3 has "Prosthesis price" for about 20 different prostheses, which varied between 370 - 1205 British pounds. Their article was written based on data published in Acta Orthoped. Scand in 1993. In 20 years I would think prices would have doubled, and you need to convert to US dollars.

If there are any orthopods or hospital administrators reading this who know what hospitals pay for various prostheses now, please feel free to offer info or a link.

My grandmother was a secretary at a casting company for a number of years and used an old, defective hip joint as a paperweight. I used to play with it when I went to stay with her, but it took me years to understand what it was. Ah, memories.

> I was tempted to ask the crematory staff what would be done with my father's gold tooth fillings (he probably had several ounces). In the end, I didn't inquire - but suppose those teeth were yanked before cremation and went into some staff member's pocket.

Ouch, that's pretty cynical! From one site's FAQ, a response I'd expect to see as standard:

"Gold fillings left with the deceased, if recoverable, will be placed with the ashes or returned to the family upon request. "

For one thing, pulling teeth from the body would be an indictable offence, interfering with a dead body or remains. For another, the great majority of people would know it's simply wrong: it's stealing, and it is certainly disrespectful aside from the fact of the theft. Any reputable firm, like any reputable firm in any other business, would not steal anything from its clients.

Teeth may be removed so that the combustion does not volatilize the mercury amalgam into the air:

"The mercury in the meantime has been released into the atmosphere. In the UK, mercury from crematoria is expected to cause 35 percent of mercury emissions by 2020. There is debate over how much, if any, mercury in the air is acceptable. US research indicates that the cremation of one human lets off 2.0 to 3.0 grams of mercury into the atmosphere. To reduce this, the US State of Minnesota has proposed legislation requiring that all mercury dental fillings be removed before cremation. The legislation requires a mortician or a supervised technician remove teeth containing fillings. This prevents the mercury being released as vapour..."

The gold is not removed by the magnet that removes other metal, so it would be mixed with the ashes, and should be returned to the family. I agree with your comment that a "reputable firm" would follow those policies, but some low-level employees may not, as was the case reported in Der Spiegel in 2007 in Germany:

"A court in Germany has convicted six former employees of a Nuremberg crematorium for collecting and selling gold fillings taken from the dead. The men made a profit of €135,000 by selling the precious metal."

So it can be done, and it has been done, and with gold selling for $1,600 per ounce, I'm sure it is being done.

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